For people with acute and subacute neck pain, spinal manipulation therapy (SMT) was more effective than medication in both the short and long term, say authors of an article published in Annals of Internal Medicine. However, a few instructional sessions of home exercise with advice (HEA) resulted in similar outcomes at most time points.

This randomized, controlled trial was conducted at 1 university research center and 1 pain management clinic in Minnesota. Participants included 272 people aged 18-65 years who had nonspecific neck pain for 2-12 weeks. Participants received 12 weeks of SMT, medication, or HEA. The primary outcome was participant-rated pain, measured at 2, 4, 8, 12, 26, and 52 weeks after randomization. Secondary measures were self-reported disability, global improvement, medication use, satisfaction, general health status (Short Form-36 Health Survey physical and mental health scales), and adverse events. Blinded evaluation of neck motion was performed at 4 and 12 weeks.

For pain, SMT had a statistically significant advantage over medication after 8, 12, 26, and 52 weeks. HEA was superior to medication at 26 weeks. No important differences in pain were found between SMT and HEA at any time point. Results for most of the secondary outcomes were similar to those of the primary outcome.